The Effectiveness of Supported Employment in People With Dual Disorders
Dartmouth Psychiatric Research Center, Departments of Psychiatry, and of Community and Family Medicine, Dartmouth Medical School.Journal of Dual Diagnosis (Impact Factor: 0.8). 01/2011; 7(1):90-102. DOI: 10.1080/15504263.2011.568360
Objective: This study compared the effectiveness of the Individual Placement and Support (IPS) model of supported employment to control vocational rehabilitation programs for improving the competitive work outcomes of people with a severe mental illness and co-occurring substance use disorder. Methods: A secondary data analysis was conducted drawing from four randomized controlled trials comparing IPS-supported employment to conventional vocational rehabilitation programs for severe mental illness and focusing on the 106 clients with a recent (past 6 months) substance use disorder. Competitive work outcomes were tracked across an 18-month follow-up period. Analyses compared the IPS and comparison vocational programs on cumulative work over the 18 months, including attainment of work, hours and weeks worked, job tenure, wages earned, and days to first job. Results: In the total study group, clients who participated in IPS had better competitive work outcomes than those who participated in a comparison program, with cumulative employment rates of 60% vs. 24%, respectively. Among clients who obtained work during the study period, those receiving IPS obtained their first job significantly more quickly and were more likely to work 20 or more hours per week at some point during the 18-month follow-up. Conclusions: The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients with dual disorders.
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ABSTRACT: OBJECTIVE: This paper addresses how consumers with dual diagnosis, who were formerly homeless but are now living in supportive housing, understand their recovery from substance abuse (i.e., substance abuse or dependence). Specifically, this study examined: What can be learned about substance abuse recovery from consumers considered to be doing well; how past substance abuse fits into their present-day narratives; and how (if at all) policies of harm reduction versus abstinence are regarded as affecting recovery efforts. METHODS: As part of a federally-funded qualitative study, 38 individuals who met criteria for having achieved a measure of success in mental health recovery were purposively sampled from two supportive housing agencies - one using a harm reduction and the other an abstinence model. Researchers conducted in-depth interviews and used case study analysis, the latter including the development of case summaries and data matrices, to focus on substance abuse recovery in the larger context of participants' lives. RESULTS: Recovery from substance abuse was depicted as occurring either through discrete decisions or gradual processes; achieving recovery was distinct from maintaining recovery. Emergent themes related to achievement included: (a) pivotal events and people (b) maturation, and (c) institutionalization. Central themes to maintaining recovery were: (a) housing, (b) self-help, and (c) the influence of significant others. CONCLUSIONS: These findings capture a complex picture of overcoming substance abuse that largely took place outside of formal treatment and was heavily dependent on broader contexts. Equally important is that consumers themselves did not necessarily view substance abuse recovery as a defining feature of their life story. Indeed, recovery from substance abuse was seen as overcoming one adversity among many others during their troubled life courses.
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ABSTRACT: Background Some Veterans, and especially those with mental disorders, have trouble reintegrating into the civilian workforce. PURPOSE: The objectives were to describe the scope of the existing literature on mental disorders and unemployment; and to identify factors potentially associated with reintegration of workers with mental disorders into the workforce.Data Sources.The following databases were searched from their respective inception dates: MEDLINE, EMBASE, Cumulative Index Nursing Allied Health (CINAHL), and PsycINFO.Study Selection.In-scope studies had both (a) quantitative measures of employment and (b) study populations with well-described mental disorders (eg. anxiety, depression, PTSD, substance-use disorders).Data Extraction.A systematic and comprehensive search of the relevant published literature up to July 2009 was conducted that identified a total of 5,195 articles. From that list 81 in-scope studies were identified. An update to July 2012 identified 1,267 new articles, resulting in an additional 16 in-scope articles.Data Synthesis.Three major categories emerged from the in-scope articles: Return to Work, Supported Employment, and Reintegration. The literature on Return to Work and Supported Employment is well summarized by existing reviews. Reintegration literature included 32 inscope articles; only 10 of these were conducted in populations of Veterans.LimitationsStudies of Reintegration to work were not similar enough to synthesize, and it was inappropriate to pool results for this category of literature. CONCLUSIONS:/b>This comprehensive literature review found limited knowledge about how to integrate people with mental disorders into a new workplace following a prolonged absence (over one year). Even more limited knowledge was found for Veterans. The results informed the next steps for our research team, to enhance successful reintegration of Veterans with mental disorders into the civilian workplace.